Not quite `007,' but it pays the bills

Private investigators check claims by injured workers for insurers

July 01, 2002|By TaNoah Morgan | TaNoah Morgan,SUN STAFF

For partners Anthony Crofton and Philip Mastramico, the secrets of their trade are simple: Act normal, try not to stand out, and be sure to get a clear shot from your pager-camcorder when you catch a disabled workers' compensation claimant lifting weights at the gym.

The private investigators, co-owners of Elkridge-based Tolle Investigative Services Inc., handle hundreds of insurance fraud cases a year, with a little common sense and a few cool toys such as a pager-video camera.

According to a local trade association, the spy business is booming, with relatively few players in the field, and Tolle is seeing the benefits. Revenue for the 9-year-old company has increased 70 percent in the two years since Crofton and Mastramico became owners, they said, and they recently added two private eyes to their team of three full-time and two part-time investigators.

The investigators act as a third party in insurance claims disputes, checking out the injured party who has been awarded a payment when the insurance company has reason to believe the injury might be less severe than claimed.

Lloyd Davis, an investigator and founder of the Professional Investigators Alliance of Maryland, warns against relying too heavily on insurance companies for business, because when disasters strike and insurance companies are forced to pay out large claims, they often curtail investigations.

"I remember a few years ago, when a tornado struck in Florida ... a few [private investigation] companies were about to fold because they put all their eggs in one basket," he said. "You've got to be able to get involved in other aspects of investigation."

For now, says Mastramico, insurance fraud cases keep business flowing.

"It's raining pretty hard right now," he said.

Insurance fraud costs Americans at least $80 billion a year, or nearly $950 for each family, according to estimates from the Coalition Against Insurance Fraud. Local and federal governments and insurance companies have become more aggressive in recent years in fighting fraudulent claims, says Dennis Jay, executive director of the group.

"They're getting more savvy and using more tools out there - technology and private investigators - and getting a gut feeling for what's not a good claim," he said.

Although insurance companies cannot afford to investigate every claim an adjuster thinks might be fraudulent, they might look more closely at workers' compensation cases in the coming months, Jay said, because these cases are on the rise.

"With the economy a little shaky, we're seeing a little bit of a rise in workers' compensation fraud. People are a little insecure about their jobs," he said. "People can easily fake pain and things like that. If people are smart and they don't get another job and don't have a disgruntled girlfriend or boyfriend, husband or wife, people tend not to get caught."

Crofton and Mastramico know how rampant fraud is. They say that of the hundreds of claims they have investigated, they found that in 2 percent to 5 percent of the cases, claimants were injured as severely, or nearly as severely, as they had claimed to be.

What happens more often is that, after a day of following a person, the investigators find the claimant is more active than most people. They've followed workers who have claimed to have injured necks and backs to their construction jobs, watched them build sheds, play tennis and dive and slide as star players on their baseball teams.

"You name it, we've gotten it ... to the point of people doing drug buys," Crofton said. "You never know where you'll end up."

Sometimes they've found themselves in dangerous situations. On one occasion, they were videotaping in a bad neighborhood and found their car surrounded by drug dealers. On another occasion, the person they were watching and videotaping approached their car with a gun.

"They know what to look for," Crofton said. "They know this game."

But so do Crofton and Mastramico.

Tolle Investigative Services opened in 1993 as Paul W. Tolle and Associates, named for its founder, a retired Anne Arundel County police detective. The company started as an investigations and security company, and Crofton and Mastramico, cousins from Pennsylvania, joined the firm as part-time investigators in 1995, seeking experience because they planned to apply to the FBI or the Secret Service. Mastramico had studied law, and Crofton, psychology and law enforcement, both at the University of Pittsburgh.

The cousins decided they liked the work enough to pursue it full time, and they held every post in the company as they worked to expand its investigative arm.

Two years ago, Tolle decided he wanted to get out of the business, and he sold the investigations portion to the cousins. He sold the security part of the company to a larger security firm, Mastramico said.

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